title: Routine preoperative blood testing in pediatric neurosurgery.
abstract: OBJECTIVE
  The frequency with which routine preoperative blood test results predict perioperative or postoperative complications is insignificant. The unnecessary ordering of routine tests increases the financial costs and patients' distress. The authors evaluated the effects of routine preoperative testing on patient management and the overall financial costs.
  
  
  METHODS
  The authors retrospectively reviewed the medical records and laboratory data for 355 children admitted to the neurosurgical department for elective procedures over a 5-year period (January 2008-December 2012). They excluded all patients admitted for imaging or surgical procedures requiring local anesthesia, and they recorded the results of preoperative and previous (up to 6 months before surgery) blood tests and any abnormalities noted.
  
  
  RESULTS
  As a result of the 3489 blood tests ordered preoperatively for 328 (94.6%) of the 355 patients, 29 abnormalities (9%) were detected. Most of these abnormal values were near the reference range, and none significantly affected the progression of scheduled procedures. For only 1 patient (0.28%) was the procedure cancelled because of an abnormality (preoperative partial thromboplastin time), which further testing showed to be a false-positive result. The cost of these tests over 5 years was 5205-10,410 euros ($6766-$13,533 US).
  
  
  CONCLUSIONS
  Preoperative tests should be selectively requested on the basis of clinical indication.
authors.affiliation: Royal College of Surgeons in Ireland; and.
authors.forename: Fajer
authors.initials: F
authors.lastname: Almesbah
authors.forename: Tafadzwa
authors.initials: T
authors.lastname: Mandiwanza
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Kaliaperumal
authors.forename: John
authors.initials: J
authors.lastname: Caird
authors.forename: Darach
authors.initials: D
authors.lastname: Crimmins
mesh_terms: D000293:Adolescent; D001772:Blood Cell Count / Q000191:economics; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D017048:Health Care Costs; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland; D008297:Male; D008499:Medical Records; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010314:Partial Thromboplastin Time / Q000191:economics; D010976:Platelet Count; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011188:Potassium / Q000097:blood; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011517:Prothrombin Time / Q000191:economics; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D019564:Unnecessary Procedures / Q000191:economics; D014508:Urea / Q000097:blood
chemical_list: D006454:Hemoglobins; D014508:Urea; D005340:Fibrinogen; D012964:Sodium; D003404:Creatinine; D011188:Potassium